Action Points

Note that this randomized trial suggested that "baby-led weaning" -- i.e., allowing an infant to feed him/herself from 6 months onward was not associated with a reduction in overweight or obesity risk, but did decrease food "fussiness."

Notably, there was no increased risk of choking in the baby-led weaning group.

Allowing infants who are being weaned to feed themselves, rather than spoon-feeding them, did not result in either healthier growth or a reduced risk for being overweight, a randomized clinical trial found.

However, mothers of self-fed infants did report that their babies were less fussy about food, appeared to enjoy it more, and ate more appropriately in response to feelings of fullness, said Rachael Taylor, PhD, of the University of Otago in Dunedin, New Zealand, and colleagues.

In addition, baby-led weaning appeared to be safe, with no increased risk for underfeeding, anemia, or choking, the team wrote online in JAMA Pediatrics.

According to the results of the trial, called BLISS (Baby-Led Introduction to Solids study), the mean body-mass index (BMI) z score of self-fed infants at 2 years of age was 0.39, compared with 0.24 for a control group of traditionally fed infants (adjusted difference 0.16; 95% CI -0.13 to 0.45). Approximately 10% of self-fed infants were overweight at 2 years, compared with 6% of the control group (relative risk 1.8; 95% CI 0.6-5.7).

Mothers of self-fed infants reported that the babies had less food fussiness (adjust difference -0.33; 95% CI -0.51 to -0.14) and greater enjoyment of food (adjusted difference 0.25; 95% CI 0.07-0.43) at 12 months compared with the control group. However, these differences were not significant at 24 months. Mothers of self-fed infants also reported that there was lower satiety responsiveness (eating less in response to feelings of fullness) compared with the control group at 24 months (adjusted difference -0.24; 95% CI -0.41 to -0.07).

"Our randomized clinical trial suggests that allowing infants greater control over their eating by using a baby-led approach to complementary feeding does not result in more appropriate body weight up to 24 months of age than traditional spoon feeding," Taylor and colleagues wrote. "Our results also refute concerns that infants using a baby-led approach to complementary feeding may not eat enough food, with no children showing growth faltering. Interestingly, infants in the BLISS group showed less food fussiness and greater enjoyment of food than control infants.

"Because of the strong genetic component to food fussiness, the relatively large effect of this baby-led approach is of interest. The differences that we observed can be considered as a moderate effect and are likely to be important to parents, because food fussiness can cause considerable stress."

In an accompanying editorial, Rajalakshmi Lakshman, PhD, of Cambridge University in England, and colleagues, said: "We learn much from this trial, despite the lack of efficacy on the primary outcome of obesity risk ... The high retention rate (80.5% at 24 months), high adherence to the intervention, and use of validated instruments to measure the outcomes of the trial provide much-needed robust evidence regarding this weaning approach, allowing definitive conclusions to be drawn.

"Of importance, the baby-led weaning intervention was safe. No group differences were noted in energy intake, growth faltering, or iron-deficient anemia ... These findings help allay concerns regarding the safety of baby-led weaning. Parents may be allowed a free choice in the manner of infant weaning, or baby-led weaning might even be encouraged as an approach to address concerns regarding infant food neophobia, food refusal, and disruptive mealtime behaviors."

BLISS included 206 women recruited in late pregnancy from 2012 to 2014 at a maternity hospital in Dunedin, New Zealand. Their mean age was 31, 82% were of European ethnicity, and 42% were having their first child. They were randomized to a control group (n=101) or to the BLISS intervention (n=105).

Mothers in the intervention group extended exclusive breastfeeding and delayed the introduction of solid foods until 6 months of age, at which point the infants were able to feed themselves. The intervention group received education and counseling on baby-led weaning, which included information and instruction on responsive feeding practices, paying attention to hunger and satiety cues, providing high-energy and high-iron foods, avoiding choking risk, and providing solid foods that were easy to pick up and eat.

Adherence to the baby-led approach was assessed by questionnaires administered to mothers at regular monthly intervals. Blinded researchers measured infants' length and weight at regular monthly intervals, including 12 and 24 months. Other outcomes, such as the infants' energy intake and food fussiness, were assessed by questionnaires given to the mothers at 12 and 24 months.

Limitations of the study included its small sample size and the fact that the participants were relatively socioeconomically advantaged, so the results might not apply to families of lower socioeconomic status, Taylor and colleagues noted.

"A baby-led approach to complementary feeding does not appear to improve energy self-regulation or body weight when compared with more traditional feeding practices, although some benefits may accrue in attitudes to food, including reduced food fussiness. Additional research is required to determine the extent to which these findings apply to infants who are using a baby-led approach without the modifications and additional support provided by the BLISS intervention."

The study was funded by Lottery Health Research, Meat & Livestock Australia, and other organizations.

Taylor and co-authors, as well as Lakshman and colleagues, reported having no conflicts of interest.

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